Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 22DL02216000 | NJ |
NPI | 1003900879 |
---|---|
Provider Name | Dr. Domenico Addiego |
First Address | Manahawkin, NJ 08050-2812 |
Second Address | Manahawkin, NJ 08050-2812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |